The high risk of physical restraint combined with high levels of physiological arousal

Vigorous risk assessments and risk management must be conducted

There is a need for newer approaches to safer physical restraint

The high risk of antipsychotics used during high periods of physical arousal

The risk of seclusion when a patient is heavily sedated

Following intramuscular rapid tranquillisation how often should a patient’s physical observations be monitored?

5-10 minutes for 1 hour, then every 30 minutes

5-10 minutes for 2 hours, then every hour

15-20 minutes for 1 hour, then every 30 minutes

15-20 minutes for 2 hours, then every hour

What intramuscular treatment can be given as an alternative to lorazepam for benzodiazepine tolerant patients?

Chlorpromazine

Promethazine

Zuclopenthixol acetate (Acuphase)

Trifluoperazine

Clozapine

Which of the following are predictors of suicide in schizophrenia?

Older patient

Female patient

Severe and relapsing course of illness

Lack of insight

Social isolation

Unemployment

Shugar and Rehaulk (1990) showed that episodes of continuous observation lasting up to how many hours helped 67% of patients?

36

48

60

72

84

Intramuscular lorazepam is associated with which of the following side effects?

Respiratory depression

Acute dystonic reaction

Paresthesia

Cardiac arrhythmia

Neuroleptic malignant syndrome

There is an informal patient who has been threatening violence towards the nursing team and is refusing any medication. Which of the following Sections of the Mental Health Act (1983) might be used in order to enforce intramuscular medication?

2

3

4

5(2)

None of the above

Which of the following are environmental factors that have been associated with an increased risk of inpatient violence?

Overcrowding

High staff morale

Low stimulation

Lack of privacy

Authoritarian conditions

How often should the levels of observation be reviewed?

Every hour

Every shift

Once a day

Twice a week

Once a week

When using intramuscular haloperidol which of the following are recommended?

Use of buccal midazolam

Pre-treatment ECG

Use of tetrabenazine

Avoiding concomitant antipsychotics

Ensuring intramuscular procyclidine is available

After how many hours does the sedative effect of zuclopenthixol acetate (Acuphase) peak?

2

4

8

12

18

24

Signs of acute organic brain syndrome, also known as delirium, should be suspected if which of the following features are present?

Command hallucinations

Visual hallucinations

Disorientation

Social isolation

Gradual onset

Clouding of consciousness

Which of the following are primary characteristics identified as predicting the potential for immediate violence or aggression?

Suspiciousness or paranoid ideation

Anxiety or pain

Inability to verbalise feelings

Poor impulse control

Refusal to communicate

Previous substance misuse

Which of the following things would you routinely do to reduce the risk when assessing an acutely disturbed patient?